Tackling the challenges of tuberculosis in South Africa

Tuberculosis (TB) remains a major global health threat. In 2023, more than 10 million people fell ill with TB, causing 1.25 million deaths annually. South Africa carries one of the highest burdens globally with an estimated 270,000 people developing TB in 2023. Effectively diagnosing and treating TB is complex, with many factors at play.  Researchers at the UCT Faculty of Health Sciences are working to tackle TB on many fronts. To commemorate World TB Day, we spotlight a few examples of cutting-edge TB research at UCT.

The TB pandemic in South Africa is compounded by several problems, including high levels of co-morbidity with both HIV and non-communicable diseases such as diabetes, which complicate the treatment of TB. Additionally, the strain on the healthcare system makes providing adequate care for TB patients challenging, and the rise of drug-resistant TB is more difficult to treat.

Addressing these challenges requires a multi-pronged approach, one of which is the development and testing of drugs to treat TB more effectively and in a shorter period. Promising research at UCT includes the use of gene-editing technology, efforts to accelerate the discovery and testing of new TB drugs, and strategies to prevent relapse in patients who have already been treated and considered cured.

Dr Melissa Chengalroyen of the Molecular Mycobacteriology Research Unit (MMRU) within UCT’s Institute of Infectious Disease and Molecular Medicine (IDM), along with collaborators in the United States, have used a gene editing tool to stop the TB bacteria, Mycobacterium tuberculosis (Mtb), from producing vitamin B2 which is needed for cellular energy balance. Mtb needs vitamin B2 to survive and multiply, so halting the production of the vitamin kills the bacteria. The team are now searching for drugs that can block Mtb’s vitamin B2 production pathway to impede the growth of the bacteria.

Dr Vinayak Singh of the Holistic Drug Discovery & Development Centre (H3D) is focused on accelerating TB drug development by establishing and optimising animal TB infection models to more effectively evaluate potential TB drug candidates. Efficient animal model studies are crucial for assessing drug efficacy and safety before human trials. By optimising these models at UCT, researchers can screen a greater number of compounds with anti-TB potential, significantly speeding up the drug discovery pipeline. This focused approach to animal model optimisation aims to enhance the predictive power of pre-clinical studies and ultimately deliver new TB treatments more rapidly.

Professor Reto Guler from the Institute of Infectious Disease and Molecular Medicine at UCT and Professor Friedrich Thienemann from the Department of Medicine at UCT and the University of Zurich are leading a clinical trial to assess the impact of widely used cholesterol-lowering drugs (statins) to reduce TB relapse and improve lung health among TB patients. The standard six-month TB treatment does not always fully eradicate Mtb, leaving patients at risk of chronic lung disease and relapse. Studies suggest that statins, such as atorvastatin, can reduce mycobacterial burden and inflammation. The ongoing StatinTB trial, led by Professors Guler and Thienemann, aims to improve lung health, reduce inflammation, and lower TB relapse rates.

Read part II in our World TB Day article series: Addressing the co-morbidity challenge around TB in SA.